Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing: A Prespecified Secondary Analysis of the HCS Randomized Clinical Trial.

Autor:	Stopka TJ; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts., Babineau DC; Research Triangle Institute, Research Triangle Park, North Carolina., Gibson EB; Department of Medicine, Boston Medical Center, Boston, Massachusetts., Knott CE; Research Triangle Institute, Research Triangle Park, North Carolina., Cheng DM; Boston University School of Public Health, Boston, Massachusetts., Villani J; National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland., Wai JM; Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York., Blevins D; Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York., David JL; Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York., Goddard-Eckrich DA; Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York., Lofwall MR; College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington., Massatti R; Ohio Department of Mental Health and Addiction Services, Columbus., DeFiore-Hyrmer J; State of Ohio Board of Pharmacy, Columbus., Lyons MS; College of Medicine, Ohio State University, Columbus., Fanucchi LC; College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington., Harris DR; College of Pharmacy, University of Kentucky, Lexington., Talbert J; College of Pharmacy, University of Kentucky, Lexington., Hammerslag L; College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington., Oller D; College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington., Balise RR; Department of Public Health Sciences, University of Miami, Miami, Florida., Feaster DJ; Department of Public Health Sciences, University of Miami, Miami, Florida., Soares W; UMass Chan Medical School-Baystate, Springfield, Massachusetts., Zarkin GA; Research Triangle Institute, Research Triangle Park, North Carolina., Glasgow L; Research Triangle Institute, Research Triangle Park, North Carolina., Oga E; Research Triangle Institute, Research Triangle Park, North Carolina., McCarthy J; Research Triangle Institute, Research Triangle Park, North Carolina., D'Costa L; Research Triangle Institute, Research Triangle Park, North Carolina., Chahine R; Research Triangle Institute, Research Triangle Park, North Carolina., Gomori S; Research Triangle Institute, Research Triangle Park, North Carolina., Dalvi N; Office of Prescription Monitoring and Drug Control, Massachusetts Department of Public Health, Boston., Shrestha S; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts., Garner C; State of Ohio Board of Pharmacy, Columbus., Shadwick A; RecoveryOhio, Office of Ohio Governor Mike DeWine, Columbus., Salsberry P; Health Behavior and Health Promotion, Ohio State University, Columbus., Konstan MW; Case Western Reserve University School of Medicine, Cleveland, Ohio., Freisthler B; College of Medicine, Ohio State University, Columbus., Winhusen J; University of Cincinnati College of Medicine, Cincinnati, Ohio., El-Bassel N; Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York., Samet JH; Department of Medicine, Boston Medical Center, Boston, Massachusetts.; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts., Walsh SL; College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Feb 05; Vol. 7 (2), pp. e240132. Date of Electronic Publication: 2024 Feb 05.
DOI:	10.1001/jamanetworkopen.2024.0132
Abstrakt:	Importance: Buprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined. Objective: To determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing. Design, Setting, and Participants: This prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list-controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Intervention: Waiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity. Main Outcomes and Measures: The rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed. Results: A total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10). Conclusions and Relevance: In this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder. Trial Registration: ClinicalTrials.gov Identifier: NCT04111939.
Databáze:	MEDLINE
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